Social and cultural influences on young Ugandan’s sexual health

The issue. Two key messages drive the UNAIDS 2011-2015 Strategy, Getting to Zero. The first is the need to intensify HIV prevention by implementing more comprehensive sexuality education and encouraging open discussion about sexuality. The second is empowering those living with HIV and AIDS – particularly young people – to demand, lead and own a transformative approach to HIV prevention.

“The best HIV responses have been transformative in their impact… It is critical that we empower and facilitate young people as change agents in activating their communities to redress harmful social norms governing sexuality, gender roles and other behaviour” (UNAIDS, 2010: 34-35).

Recent research suggests that NGO-led HIV prevention and sexual health programming is too often focussed on the individual aspects of empowerment, based on the assumption that building individuals’ knowledge and life skills alone will un-problematically lead to informed decision-making and action.

This blog cautions against too strong a focus on the individual. It draws on recent research using age and gender as lenses through which to analyse the consequences of young people’s relationships, and the influence of social context on sexual behaviours and practices. The focus is on the informal aspects of rural Ugandan society, which determine how young people should or should not behave. NGO practitioners may find it helpful to use the concepts of ‘doing gender’ and ‘performing age’ – explained below – to design programmes which work against the vulnerability that affects young people’s lives in relation to HIV and sexual health.

Doing gender. Doing age. ‘Doing gender’ and ‘performing age’ describe the ways in which people produce, live through and reproduce gender and age inequalities in society. By engaging in the process of behaving in, thinking about, or even feeling in the ways that a society prescribes to women and men, of different ages, each person actively enacts gender and age over and over again. This process makes it virtually impossible to ‘see’ the production of gender and age, and the vulnerability that arises from doing so, until one is aware of this process (Melendez and Tolman, 2006; Laz 1998).

The study. This briefing draws on findings from a qualitative study undertaken in rural Uganda. Work examined everyday life for young people aged 11-24 years in Iganga, Mbale and Mpigi Districts, with a focus on HIV and sexual health and NGO empowerment strategies to improve sexual health. Data collection included: 48 interviews with representatives from NGOs, central government and bi-lateral development agencies; 52 single-sex focus group discussions and 117 in-depth interviews with young men and women; 82 interviews with parents, teachers, religious leaders, local clan leaders, community-based NGO/CBO workers and local government staff; and ethnographic research with 23 of the 117 young people previously interviewed.

Lessons learned. A range of age and gender-based beliefs influence young people’s sexual health:

• Sex as an adult privilege. Before marriage, boyfriend-girlfriend relationships tend to be regarded as unacceptable, whether or not the relationships are sexual. If young people become sexually active early, this has to happen secretly to avoid negative repercussions. But this secrecy creates vulnerability by limiting access to support networks, health services, and information regarding sexual health.
• Gendered sexuality. Discussion about ‘promiscuity’ revealed that girls are judged more negatively than boys with regard to sexual conduct. Girls should remain in control of their sexuality, while boys are allowed to try their luck without being judged so harshly. For boys, vulnerability arises from complex messages which both discourage and yet permit them to have sex. Girls must negotiate sexual pressure from boys along with wider expectations to maintain a good reputation.
• Respecting elders. It is disrespectful for young people to argue with, disobey or question their elders. This respect sets restrictions on young people’s ability to make independent decisions about their lives and futures. Respect for elders discourages young people from talking about their sexual experiences and seeking advice, and limits their capacity to seek community health services. Having a good reputation is dependent on behaving well, which translates into young people’s sexual relationships remaining hidden and taking place in private.
• Living for adulthood. Despite age setting limits on young people’s behaviour, there are transitional markers en route to adulthood (eg. the onset of puberty, first menstruation, and cultural ceremonies marking a transition to adulthood). Anticipation of adulthood, especially in terms of preparation for sexual relationships, is at odds with parental pressure on young people to behave as children.
• Gendered roles and responsibilities. The division of labour at home tends to restrict young women’s movement. Parental control means that young women have fewer opportunities to develop relationships with people with whom they can share worries, seek sexual health advice, or generate independent income. This increases the likelihood of girls seeking a boyfriend as a livelihood strategy.  Sexual experiences become opportunistic, rushed and hidden away, with limited support before, during, or after the event.
• Adult-centric community health workers and services. Advice that condoms and family planning are for adults is often based on an assumption that young people should not be having sex. Few youth-friendly services exist in rural health centres, and where they do, they rarely offer appealing services. Uptake of youth-friendly services is inhibited by: being ill-timed and poorly located; distrust of local adult health workers; overbearing staff lecturing young people about abstinence and the need to refrain from sexual relationships.
• Limited dialogue with parents about sexuality. Gender norms and parents’ own insecurities impact on their willingness, confidence and ability to teach their children. Parents said it was important for young people to learn about sexual health, but they need to know more to educate their children, friends and family members.
• Limited dialogue with teachers about sexuality. Teachers do not discuss the emotional aspects of HIV and AIDS, and find it difficult to speak to students about sex beyond biology because of cultural expectations. Fear of being judged and disciplined prevents students talking openly to teachers.
• Young people reproduce the past. Young people (grow up to repeat that condoms and family planning are for adults, along with the expectation that boys are and should be responsible for deciding whether to use condoms, arranging meetings, and for decisions regarding abortions.
• Young people’s secretive sex. The idea that sex is an adult privilege and that young people should not have sex before marriage lies at the root of young people’s sexual health vulnerability. These ideas encourage young people to have sex in secret which subsequently restricts their ability to deal with problems that arise during a relationship.

Enhancing impact of policy and programming. Study findings have important implications for HIV prevention and sexual health programming. Ways to enhance the impact of future work include:

• aligning programme assumptions with the realities of young people’s lives, starting from the basis that young women and young men – albeit for different reasons – will continue to engage in sexual activities, whether or not adults find this acceptable.
• reducing young people’s sexual health risks by designing programmes which aim to link young people to supportive local social and professional networks.
• designing and implementing programmes that positively influence relationships between young people and adults, and encourage dialogue about age and gender as they affect young people’s behaviour.

This may require:

• skills development and HIV and sexual health awareness located within interactive and self-reflective dialogue about young people’s sexuality. Facilitators sensitive to young people’s worries about confidentiality are important.  Such dialogue should take place in spaces considered safe without adverse consequence for young participants.
• building young people’s ability to participate in dialogue and negotiation with adults (eg. parents, teachers, extended family members and community health workers).
• programmes with adults to ensure they are able to participate comfortably in such dialogue, acknowledging that change may be required to their own attitudes, and understanding what impact change will have on broader society.
• dialogue with adults about their own sexuality and sexual health to build bridges across age and gender divides.

Refs: UNAIDS (2010), Getting to Zero. 2011 – 2015 Strategy; Ingham, R. (2006), “The importance of context in understanding and seeking to promote sexual health”, in Ingham, R. and Aggleton, P. (Eds.) Promoting young people’s sexual health. International perspectives [let me know if you want a copy of this chapter!]

Young people and sexual agency in rural Uganda

The issue. The extent to which young people in rural Uganda are informed and are free to make choices about sexual behaviour depends on their relationships with peers, parents and other adults, as well as social, cultural and economic influences. This briefing paper highlights how young people negotiate these influences when becoming involved in sexual relationships, and the consequences by:

• helping to understand how young people’s decisions and actions impact upon their sexual health and other aspects of daily life;
• enabling practitioners a more realistic starting point from which to design and implement HIV prevention and sexual health programmes influenced by the realities of young people’s sexual lives.

The study. This blog follows on from the previous two, drawing on findings from a qualitative study undertaken in rural Uganda. The research examined everyday life for young people aged 11-24 years in Iganga, Mbale and Mpigi Districts, with a focus on HIV and sexual health, and NGO empowerment strategies to improve sexual health. Data collection involved: 52 single-sex focus group discussions and 117 in-depth interviews with young men and women; 82 interviews with parents, teachers, religious leaders, local clan leaders, community-based NGO/CBO workers and local government staff; and ethnographic research with 23 of the 117 young people previously interviewed.

Lessons learned. Young people become involved in relationships for various reasons:

• Feelings and emotions. Many young people believe that sex is a natural part of growing up. The positive emotions of love and affection are often cited as reasons for starting a new relationship. For young men, relationships help them to deal with difficult emotions (eg. physical attraction, frustration, worry and anxiety),  challenges (eg. dropping out of school, lack of income) and feelings of self-respect and maturity.
• Social pressure. Young women complain of pressure from adults and older boys persuading them into sexual relationships and are also concerned about rape. For boys, peer influence is largely a positive factor in encouraging them to embark on relationships.
• Financial and material support. Boyfriends’ financial and material support helps young women meet their basic living needs. The majority of girls who accept gifts and financial assistance from boyfriends are from rural families struggling to meet subsistence needs, single-parent families where the lone parent was female, families headed by step-parents or guardians, or larger families dependent on subsistence agriculture.

Young people employ a number of strategies to ensure that their relationships remain secretive. Also to reduce the chance of early pregnancy, school drop-out, parental punishment, social exclusion, fines and imprisonment.

• Secret meetings. Meetings with partners typically take place in ‘safe’ places, (eg. ‘in the bush’ amongst the dense foliage, or at the boy’s home), away from adult supervision during the school day (eg. to and from school, during lunch breaks) and whilst undertaking chores (eg. fetching water, buying goods).
• Using contraceptives to prevent pregnancy. Young people have limited access to condoms due to limited stocks in health centres, health centre staff being unwilling to distribute condoms to young people and because of their own fear of judgment and gossip from buying from local stores. Young men adopt various strategies to obtain condoms, including acquiring them from youth-led condom distribution networks or from health centre-provided condom dispensers at night.
• ‘Mythical’ contraceptive strategies to prevent pregnancy. Young women are vulnerable to myths and misinformation about sex and contraception which lead them to employ ‘mythical’ contraceptive strategies. These included having sex during ‘safe’ days following menstruation, using local herbs wrapped in a small cloth tied to a cord around the waist during sex, and taking Panadol tablets before sex.

Disempowering outcomes arise when sexual relationships become public knowledge in unsupportive social contexts:

• Social exclusion. Young women often drop out of school after unplanned pregnancy, and/or are punished by parents. Punishments take various forms, such as increased domestic chores, reduction or withdrawal of financial support, and isolation from friends. Young men can be forced to move away from their home area and have the fear of legal punishment for defilement.
• Increased poverty. Early marriage and single motherhood can exacerbate poverty and extend it beyond the family home as young people struggle to develop livelihoods and raise sufficient income to support themselves and their new families. Boys experience new, unexpected financial pressures to provide for their girlfriends’ needs.

Enhancing impact of policy and programming. Young people know what they are doing in relation to their sexual lives. They can articulate their desires and feelings, and act on these in ways which fulfill their own needs. However, because they live in communities where sexual behaviour is forbidden, the are also vulnerable as a result of:

• inability to rely on local institutions and organisations (eg. NGOs, CBOs, teachers and health centre staff) for support and advice;
• social exclusion and the consequent narrowing of support networks and opportunities to discuss problems and seek sexual health advice for ways to respond positively to their situation;
• lack of good understanding of sexuality and health, including the use of ‘mythical’ contraceptive strategies.

An understanding of young people’s sexual agency and its consequences enables practitioners to design HIV prevention and sexual health programmes better informed by the realities of young people’s sexual lives. Three lessons can be identified for future work:

• Future programmes should be based on the knowledge that young people are sexually active and will continue to be, in spite of local pressures to prohibit this;
• Young people are aware of the consequences of sexual relationships becoming public knowledge, having seen lives of friends and acquaintances unravel. Despite this, young people are still prepared to take chances, primarily to satisfy emotional and financial needs
• Support should be available to young people before and during sexual relationships to reduce sexual health risks and the disempowering consequences that arise when sexual relationships become public knowledge.

Further reading: Stephen Bell, 2011, Young people and sexual agency in rural Uganda; Helle Samuelsen, 2006, Love, lifestyles and the risk of AIDS: The moral worlds of young people in Bobo-Dioulasso, Burkina Faso.

Using ethnography in NGO monitoring and impact evaluation

The issue. Two recent developments have implications for understanding and measuring impact in international development:

• a concern to find ways of monitoring programmes and assessing impact that are more grounded in the local reality of change than some current ‘results-based’ methods;
• a growing call for greater use of close-to-the-ground methods in NGO programme evaluation which offer a richer way of assessing relationships between intent, action and change.

Drawing on recent research findings, this blog reveals how using ethnographic evaluation – which we have defined as qualitative research underpinned by ethnographic principles for evaluative purposes – alongside existing M&E approaches may enable practitioners to strengthen HIV prevention and sexual health programme delivery.

Ethnographic evaluation. Monitoring and Evaluation (M&E) research aims to understand and evaluate success and is an integral dimension of programme design and implementation. It serves several purposes: learning; attribution of cause and effect; accountability and credibility; and advocacy.

Ethnography is a method, or set of methods, whereby a researcher participates overtly or covertly in their subjects’ daily lives, typically for an extended period of time. It aims to understand and describe cultures and experiences of lives from within, as well as the beliefs and social rules that affect the way people behave. Ethnographic evaluation adapts these methods and aims to the purpose of programme decision-making, based on local interpretations of programme efficacy and impact.

Ethnographic evaluation offers an opportunity to respond to recent criticism of current M&E practice by proposing changes to better capture the depth and complexity of social change programming. It does this by:

• tracking and understanding change in local cultures, attitudes and practices, rather than against project goals or ‘theories of change’
• tracking and interpreting backlashes and resistance to change, viewing these findings as evidence of impact and effectiveness rather than programme failure
• assessing the contribution of different factors to change rather than attribution (eg. simple cause and effect).

Drawing on ethnographic principles, this new approach…

• strives to be context-sensitive
• aims to explore how different participants construct and interpret a programme and its effects in the light of their social realities and meaning systems
• elicits different voices in changing social contexts through its emphasis on rapport and relationship building
• aims to be reflexive, with the evaluator being self-critically aware, questioning the influence of their own behaviour, attitudes and values on the research
• utilises participant observation, key informant interviewing and participatory techniques to collect in-depth qualitative data to aid programme decision making
• requires findings, interpretation and inference to be cross-checked against one another through processes of ‘triangulation’

The study. This briefing draws on findings from a qualitative study undertaken in rural Uganda. The research examined everyday life for young people aged 11-24 years in Iganga, Mbale and Mpigi Districts, with a focus on HIV and sexual health, and NGO strategies to improve sexual health. Data collection included: 48 interviews with representatives from NGOs, central government and bi-lateral development agencies; 52 single-sex focus groups and 117 in-depth interviews with young men and women; 82 interviews with parents, teachers, religious and clan leaders, NGO/CBO and local government staff; and ethnographic research with 23 of the 117 young people previously interviewed.

Lessons learned. Ethnographic evaluation enables NGO staff to locate programme design and implementation within the context of young people’s lives in several ways.  In the present study, findings suggest that ethnographic evaluation may help in:

• improving programme principles and assumptions, so as to develop more culturally-attuned HIV prevention and sexual health programme models. Social beliefs that sex is an adult privilege and that young people should not have sex before marriage, lie at the root of young people’s sexual health vulnerability by encouraging young people to have sex in secret. Improving the sexual health of young people requires action to tackle the social, cultural and economic influences that increase their vulnerability. However, strategies employed by case study NGO programmes focused prominently on building young people’s knowledge and life skills, without sufficient attention to either their relationships with other people or the social, cultural and economic drivers of vulnerability.
• understanding socio-cultural logic, allowing NGO staff to appreciate what lies behind young people’s attitudes and behaviours. Young people engage in sexual relationships whether adults find it acceptable or not. Secret meetings and the use of contraception (including ineffective strategies) are used by young people irrespective of whether their behaviour conforms to the messages promoted by NGOs (eg. abstain or use a condom). If NGO practitioners are unaware of sexual practices which may be hidden from adults because they run contrary to social expectations, programmes may fail to adequately cater for young people’s needs.
• identifying and explaining unexpected sexual health outcomes. Many young people experienced social exclusion as a result of their sexual relationships becoming known. Unplanned pregnancy can lead to girls being excluded from school. Parental punishment of daughters often takes the form of increased domestic chores, withdrawal of school fees and a reduction in pocket money. Increased poverty can also be an issue for young people who find themselves with new financial responsibilities, unexpected pregnancy, early marriage or single motherhood. NGOs need to help young people deal with these unintended outcomes as part of HIV prevention and sexual health programming.
• understanding local barriers to programme delivery and participation. Attending to local culture can help improve programme efficacy and appeal. Inappropriate timing and poor planning and delivery of activities can lead to decreased uptake of health services. Young people’s participation in programmes may fall because of the gap between young people’s own priorities (generating a sustainable livelihood) and NGO agendas (promoting sexual health).

Enhancing impact of policy and programming. There is ‘added value’ by incorporating ethnographic evaluation into existing NGO M&E research. When carried out sensitively and effectively, ethnographic evaluation enables practitioners to get closer to the everyday lives of programme participants to understand the programme from their point of view. The critical edge provided by an ethnographic approach may fit the needs of NGOs wanting to improve organisational approaches to delivering social development programmes. Whilst results-driven M&E may meet pressure for upwards accountability to donors, an ethnographic approach offers an opportunity to shift the focus of evaluation back to learning and advocacy.

Next steps in developing ethnographic evaluation include:

• overcoming NGO sector capability limitations in relation to qualitative research and ethnographic enquiry. Training is needed to nurture the development of ethnographic skills in social development contexts. This may involve training NGO staff on how to ask and learn from open-ended questions rather than overly structured interview guides; record relevant and important observations during research; analyse the range of qualitative data produced in ethnographic research; and use this array of data to write reports that enable learning to be used for programming improvement.
• designing ethnographic evaluation approaches in collaboration with NGOs to ensure that they fit with existing M&E systems and do not add extra burdens on time and financial constraints.
• getting qualitative research and ethnographic evaluation onto donor and policy-maker agendas by demonstrating that this style of evaluation can significantly improve understanding of programme design and impact.

Further reading: Srilatha Batliwala and Alexandra Pittman, 2010, Capturing change in women’s realities. A critical overview of current monitoring and evaluation frameworks and approaches; Merrill Singer, 2009, “Interdisciplinarity and collaboration in responding to HIV and AIDS in Africa: anthropological perspectives”

Time to invest in ‘counterpublic health programming’ with sexually active young people

The issue. Young people in Uganda have sex in a context where social, moral and cultural values held by adults and state authorities actively discourage this. This poses challenges for how best to design and implement HIV prevention and sexual health programmes which go beyond admonition and abstinence, and which provide young people with the advice and support they need.

This blog explores how young people may be facilitated towards a more self-determined and safer sexual life in rural Uganda. Our hope lies in identifying a new kind of youth-centred approach guided by what has been described as ‘counterpublic’ health – an approach which looks honestly at what young people are doing and uses the counterpublic to identify alternative and less constraining ways of engaging with young people’s sexual health concerns.

Counterpublic health programming. Where societal inequality exists, public decision-making tends to operate to the advantage of dominant groups. In such circumstances, subordinate groups lack opportunities to find the right voice or words to express their thoughts and ideas, and are less able to articulate or defend their interests. The idea of the counterpublic has been developed to describe grassroots responses to the marginalization of subordinated groups in everyday life and official public arenas.

Health interventions are most effective when they adhere to the values of target groups. This can be complicated when health risks evolve from taking part in ‘illicit’ activities which fall outside the boundaries of what is perceived as morally acceptable. In reaction to this, recent HIV prevention work has used the term ‘counterpublic health’ as an opportunity to strengthen programmes and interventions by:

• understanding how alternative ‘unacceptable’ sexual behaviours evolve
• reframing public perceptions about ‘immoral’ behaviours affecting people’s health
• challenging and changing public assumptions about what is acceptable.

Counterpublic health programming involves a deliberate attempt to challenge the ways in which certain practices and experiences get treated as immoral and unacceptable, and recognises the importance of valuing people’s everyday practices and pleasures in HIV prevention and sexual health programming.

The study. This briefing draws on findings from a qualitative study undertaken in rural Uganda. The research examined everyday life for young people aged 11-24 years in Iganga, Mbale and Mpigi Districts, with a focus on HIV and sexual health, and NGO empowerment strategies to improve sexual health. Data collection included: 48 interviews with representatives from NGOs, central government and bi-lateral development agencies; 52 single-sex focus groups and 117 in-depth interviews with young men and women; 82 interviews with parents, teachers, religious and clan leaders, NGO/CBO and local government staff; and ethnographic research with 23 of the 117 young people previously interviewed.

Lessons learned. Age and gender influence young people’s sexual health, and young people adopt counterpublic health strategies to protect themselves from unwanted sexual health outcomes.

• Sex as an adult privilege. Before marriage, boyfriend-girlfriend relationships tend to be regarded as unacceptable, whether or not the relationships are sexual. If young un-married people do become sexually active, they do so secretively to avoid negative repercussions. This secrecy makes them vulnerable by reducing the likelihood of them accessing support networks, health services and information regarding sexual health.
• Respecting elders. It is disrespectful for young people to argue with, disobey or question their elders. This respect carries inherent restrictions on young people’s ability to make independent decisions about their lives and futures. An inhibiting respect for elders and adults discourages young people from talking about their sexual experiences with them and seeking advice.
• Secretive sex. The idea that sex is an adult privilege and that young people should not have sex before marriage lies at the root of much of young people’s sexual health vulnerability. These ideas encourage young people to have sex in secret, restrict young people’s ability to deal with problems that arise during a relationship and increase their vulnerability to sexual health problems.
• Young people’s counterpublic health strategies. Examples include: meeting partners in secret to avoid parental punishment; seeking advice from partners and friends to learn about sexual health; expressing a desire to learn more about preventing unwanted pregnancies and STI transmission; using condoms, family planning strategies, and a range of other ‘mythical’ contraception strategies (e.g. taking panadol, using safe days).

Study findings highlight major opportunities for improving HIV prevention and sexual health programming:

• A broader focus on sex, sexual relationships and sexual health (rather than just HIV and AIDS) to enable long-term impact by tackling the root causes of vulnerability.
• More discussion with young people about sexuality, enabling practitioners to understand young people’s own perspectives on sexual practices and the drivers of poor sexual health outcomes.
• Greater use of clubs and activities – designed and implemented for and by young people – which offer ‘safe spaces’ in which young people can discuss sexuality-related issues which they perceive as relevant to their lives, across age and gender, without fear of being judged.
• Training in participatory and ethnographic research for practitioners to elicit and build programmes around young people’s views.
• Decrease reliance on adult-led, adult-determined activities and curriculum development for sexual health and sexuality education with young people.
• Re-evaluation of the attitudes held by some NGO staff – e.g. anti-contraception and pro-abstinence – which prohibit programming centred around young people’s sexual health needs.
• Complement irregular, large-scale awareness-raising community events with activities facilitating more personal and regular forms of interaction between NGOs and adult community members, and active dialogue between young people and adults about sexual health.
• Train teachers and health workers how best to discuss the emotional aspects of HIV and AIDS, sexual health and sexuality in a supportive manner with young people.

Enhancing impact of policy and programming. Young people in rural Uganda are actively involved in sexual relationships that run contrary to dominant moral codes. In these contexts, vulnerability and sexual risk are high and sexually active young people become hard to reach. This poses challenges for practitioners on how best to help young people to be involved in safe, healthy sexual relationships in ways that do not put the organisation’s own future at risk in a tightly policed and morally constrained context.

There is value in utilising a counterpublic health approach to find alternative, less constraining ways of engaging with young people’s health issues and problems. This may include:

• offering young people safe space to consider their needs and objectives and also strategies for finding the right voice and words to express their thoughts
• emphasis on action and community dialogue based on the realities of young people’s lives, to challenge moral attitudes and beliefs increasing young people’s vulnerability to poor sexual health
• strengthening young people’s ability to participate in dialogue and negotiation with adults with the aim of overcoming existing barriers to communication and transforming some of the negative social influences on young people’s lives
• working with adults to ensure that they are able to participate comfortably within such dialogue and acknowledge that change may be required in adults’ attitudes
• encouraging practitioners to position their work firmly in the realities of young people’s lives, with a focus on harm reduction and supporting those elements of sexual practice that are relatively safe from a sexual health point of view
• undertaking more in-depth studies aimed at understanding the innovative protective counterpublic sexual health strategies that young people already employ to inform the design of future HIV prevention and sexual health programmes.

Further reading: Nancy Fraser, 1990, “Rethinking the Public Sphere…”; Kane Race, 2009, Pleasure consuming medicine, Chapter 6

Introductions…

This is all about alternative ways of thinking about and doing social development programming. Ideas are located within a general interest and intrigue in people, and how and what they think about their own lives, the lives of people around them, and the challenges and opportunities they face on a daily basis.

It comes from a general belief that things could be done differently, and more effectively, within the NGO and international development policy sector, and draws on ongoing career experiences within academic, charity and public sectors, living and working in Majority and Minority world settings.

These are just ideas, which have kept changing, and no doubt will keep changing. Please contribute to them, criticise them and develop them at your will. By doing this we all keep learning and thinking and learning and…